EUREQUO AND PATIENT OUTCOMES IN CATARACT AND REFRACTIVE SURGERY

An ambitious project which seeks to add patient-reported outcomes to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) database will shortly get under way thanks to funding from the ESCRS. This ESCRS project is the brainchild of Swedish ophthalmologist Mats Lundstrom MD, PhD, who led the initial development of EUREQUO, and Konrad Pesudovs MD, PhD, based at the Department of Optometry and Vision Science at Flinders University and Flinders Medical Centre, Adelaide, Australia. As Dr Lundstrom points out, EUREQUO has been very successful in collecting data on cataract surgery outcomes, with more than 1,000,000 cataract extractions having been reported to the database over the past three and a half years. However, the registry is still missing a vital part of the jigsaw in order to make the database truly comprehensive patient-reported outcomes. The concept of cataract surgery outcomes includes four different areas: visual outcome, refractive outcome, complications and patient-reported outcomes, said Dr Lundstrom. While the existing EUREQUO database includes the first three areas there is no data on patient-reported outcomes. This is a vital missing part which needs to be included if the purpose of the EUREQUO project is to completely reflect cataract surgery outcomes, he added. The refractive surgery database has been slower in growth, but data is being entered in increasing volume, notes Dr Lundstrom. However, as with the cataract registry, patient-reported outcome remains a key missing ingredient of the database. We were extremely happy with the adoption of our research project by the ESCRS. This essentially means that the ESCRS, a society very oriented towards technical issues within ophthalmic surgery, also recognises the importance of patient reported outcomes, said Dr Lundstrom. The key to making the project work, explained Dr Lundstrom, is to ensure that the questionnaires that form the basis of the patient-reported outcomes have been developed and tested to the highest levels of validity. In terms of content, a cataract surgery outcome questionnaire should evaluate activity limitations in daily life due to visual loss caused by cataract. The questionnaire should also be short and suitable for patients self-administration to streamline implementation. Patients need to fill in the questionnaire before surgery and three months after surgery. The questionnaire should be scored using Rasch analysis to provide legitimate interval scoring and constructed and validated by modern psychometric techniques, he said. Quality of life Dr Lundstrom said that a recent publication evaluating different available questionnaires identified the Catquest-9SF as the ideal questionnaire for cataract surgery and the Quality of Life Impact of Refractive Correction (QIRC) for refractive surgery. Our aim is to offer the possibility for all surgeons and scientists to include patient-reported outcomes in their outcome studies and clinical practice. The project aims at performing translations and validation studies of these two questionnaires in a number of European languages. We hope to be able to offer the translated questionnaires as a free benefit for anyone who wants to use them in clinical practice. Our conviction is that tools for quality assurance in clinical practice should not be limited by licenses or copyrights. Once the project is up and running, clinics or surgeons participating in the EUREQUO database will have the opportunity to connect the patient questionnaire to their data collection of outcomes for a limited period of time. This will enable surgeons to compare with other clinics on what disability level their patients are operated on and the magnitude of improvement after surgery. Collecting data on patient-reported outcomes will also generate new information about patient satisfaction with vision and indications for cataract surgery. This will benefit both patients and surgeons, concluded Dr Lundstrom.